Part 1: Stress – the Silent Killer “What’s Happening Inside ” (3 Part Series)

Dec 9, 2019 | Hormones, Stress and Adrenals

By Randi Mann, WHNP-BC, NCMP, APNP

Your body was designed to respond to short bursts of stress followed by many days of rest and relaxation. For almost all of our patients, this is not their reality. Many of them have been dealing with the effects of long term stress for many months or years.

Too much stress can wreak havoc with your stress response system called the Hypothalamic/Pituitary/Adrenal (HPA) Axis.

Symptoms of HPA Axis dysfunction include:

  • difficulty falling and staying asleep
  • feeling tired or exhausted later in the afternoon or after dinner
  • tired but wired at night
  • nervous energy or jittery
  • irritable and unable to control temper
  • forgetful
  • crying for no reason
  • unexplained weight gain around the middle
  • high blood sugar
  • heart palpitations
  • fatigue
  • anxiety and depression
  • food cravings for salt or sugar
  • sensitive to noise
  • very difficult to get out of bed in the morning
  • experience energy crashes during the day
  • need for caffeine or other stimulants during the day
  • feeling stressed out almost all of the time
  • falling asleep when you don’t wish to such as when watching a movie or reading
  • sleep is no longer refreshing
  • GI symptoms such as gas, bloating, constipation, nausea, heartburn
  • weakened immune system and get sick more easily and frequently
  • worsening menopause or andropause (name of “male menopause”) symptoms

In the past, some may have erroneously called this condition adrenal fatigue or adrenal exhaustion. Actually it is much more complicated than your adrenal glands getting too tired so they can no longer produce the stress hormones called cortisol and DHEA. Low cortisol and DHEA levels may be caused by stress and most likely reflect HPA axis adaptation (down-regulation) to protect the body from excess cortisol and have little to do with the continued ability of the adrenal glands to produce hormones.


Your body needs DHEA to balance Cortisol and make many other hormones!


DHEA is a precursor hormone (is the raw material) used to make many other hormones in your body. Your adrenal glands act as the “back-up team” for a woman’s ovaries by producing lower levels of sex hormones after she reaches menopausal. Very low levels of DHEA begin to deplete many other hormones in your body including estrogen and testosterone. Once this happens a woman’s menopausal symptoms may return or worsen. For example – symptoms of hot flashes and night sweats may start or become more intense.


Your stress response system includes three endocrine glands (hypothalamus, pituitary, and adrenal) and the sympathetic nervous system. These glands and your nervous system work together to regulate your body’s stress response. This is called the fight-or-flight response. This is needed when you are in imminent danger to quickly respond to any threat. The limited release of the hormones cortisol and adrenaline into the bloodstream prepares the body to react to the danger. Chronic stress, however, causes a continuous release of these hormones which can be damaging to the body.  Adrenaline release can also cause a hot flash!

Under normal circumstances, cortisol is produced when needed and DHEA, another adrenal gland hormone, acts to counterbalance it. It is important that your cortisol and DHEA ratios remain balanced. The brain “feel good” chemicals serotonin and gamma-aminobutyric (GABA) help as well to buffer your stress response and are important counterparts to the fight-or-flight chemicals epinephrine (adrenaline) and norepinephrine. Too much stress over time depletes these relaxing neurotransmitters. Maintaining cortisol to DHEA ratios as well as ample amounts of Serotonin and GABA, is vital to keeping a positive mental outlook.


It is possible to assess your stress response system with lab testing.


Testing your cortisol and DHEA levels can be very helpful to determine if your HPA axis is functioning properly and to assess what stage of HPA imbalance you are in.


At Wise Woman Wellness we order baseline Cortisol and DHEAS testing to be done before your first visit so we can review the results with you at your visit.

Cortisol is tested in saliva four times during the day – when you awaken, before lunch, before dinner and before bed – to assess your circadian or diurnal rhythm. It is expected that you will have the highest amount of cortisol in the am shortly after awakening and your levels will fall progressively until their lowest during the first few hours of sleep. DHEA is measured in a form called DHEAS in saliva from your first-morning saliva collection. Both cortisol and DHEAS are tested from saliva that you collect in the privacy of your own home.


**Hint – it can take up to 15-30 minutes for some patients to collect the recommended amount of saliva needed each time. Please drink at least 8 glasses of water the day before and the day that you plan to test so you will be well hydrated!

Deviation from the expected results means that you are experiencing HPA dysfunction and your levels help us to identify what stage of dysfunction you are in. Each stage requires different treatments.


The 3 stages of HPA Dysfunction are typically defined as follows:

Stage 1: Alarm phase (hyper-cortisol) or activation phase

“Tired and Wired” – agitated, anxious, restless, difficulty falling and staying asleep, weight gain, insulin resistance

Stage 2: Resistance phase (cortisol – dominant) or Adaptation phase

“Stressed and Tired” – may be due to years of mild stress without adequate relaxation and recuperation. Moderately stressed and tired. May feel driven or over-reactive. May increase alcohol and tobacco use.

Stage 3: Exhaustion phase (hypo-cortisol) or “Depression phase”

neurotransmitters are “burned out”, depressed, exhausted all the time and esp. in the evening, low pulse, may suffer from pain, allergies, less able to handle stress and may shake in times of even small stress or crisis, anxiety, irritability, slow wound healing, other hormonal imbalances.

Stress is caused by more than mental or emotional stressors

When most people think of stress they usually define it as related to an emotional or mental event such as job loss, death in the family or going through a divorce. There are 3 other key drivers of stress in the body as well – blood sugar imbalances, inflammation, and inadequate sleep.


4 Key Human Body Stressors

  1. Mental and emotional stress
  2. Blood sugar imbalance
  3. Sleep cycle disturbances
  4. Inflammation


At Wise Woman Wellness we assess your specific stage of HPA Dysfunction and key driving stressor(s) and determine specific actions for you to take to improve your symptoms and your overall health.

By getting to the root cause(s) and formulating your personalized treatment plan, we can significantly decrease your recovery time and help you feel much better!

Reference: The Role of Stress and the HPA Axis in Chronic Disease Management by Thomas Guilliams, PhD. (2015).



Randi Mann, WHNP-BC, NCMP, APNP, is a woman’s hormone expert and the owner of Wise Woman Wellness LLC, an innovative wellness and hormone care center at 1480 Swan Road, De Pere. Mann is the author of the eBook: A Guide to Gluten and Going Gluten Free. She is a board certified Women’s Health Nurse Practitioner and NAMS Certified Menopause Practitioner, one of a handful in Wisconsin and less than 1600 worldwide to achieve this distinction. She combines the best of conventional, functional and integrative medicine to help women with female, thyroid and adrenal hormone issues to live healthier, more abundant, joy-filled lives using a blend of compassion, cutting edge science, practical guidance and humor. Contact her at 920-339-5252 or via the Internet at Attend the introductory seminar, “End Hormone Havoc – Crazy Hormones Cause Fatigue, Weight Gain and Brain Fog and How to Fix Them!”, offered monthly, to learn about specialized thyroid, adrenal and female hormone testing and customized, bioidentical hormone treatments to achieve lifelong optimal hormone balance, increased vitality and longevity.